Optimal control of innate immune response

Treatment of a pathogenic disease process is interpreted as the optimal control of a dynamic system. Evolution of the disease is characterized by a non-linear, fourth-order ordinary differential equation that describes concentrations of pathogens, plasma cells, and antibodies, as well as a numerical indication of patient health. Without control, the dynamic model evidences sub-clinical or clinical decay, chronic stabilization, or unrestrained lethal growth of the pathogen, depending on the initial conditions for the infection. The dynamic equations are controlled by therapeutic agents that affect the rate of change of system variables. Control histories that minimize a quadratic cost function are generated by numerical optimization over a fixed time interval, given otherwise lethal initial conditions. Tradeoffs between cost function weighting of pathogens, organ health, and use of therapeutics are evaluated. Optimal control solutions that defeat the pathogen and preserve organ health are demonstrated for four different approaches to therapy. It is shown that control theory can point the way toward new protocols for treatment and remediation of human diseases. Copyright # 2002 John Wiley & Sons, Ltd.